Guiding Significance Of Ultrasounic Typing Of Renal Tuberculosis On The Clinical Treatment

Background and objectiveRenal tuberculosis, that often leads to other urogenital system tuberculosis, is the common specificity infectious diseases in the urogenital system. In recent years, the incidence of renal tuberculosis in China has a tendency to rise. The clinical symptoms of renal tuberculosis usually are found when tuberculosis has existed or when tuberculosis has been cured after years. The clinical symptoms of renal tuberculosis have no specificity, so it is difficult to make the clinical diagnosis. Ultrasound examination has been widely used for its convenience, low price and non-invasive quality and provides the visual imaging for the diagnosis of renal tuberculosis as a diagnostic basis.Renal tuberculosis has different pathological development phases, so ultrasonic images of renal tuberculosis are varied and complex. Nonspecific performance of ultrasonic images leads to higher misdiagnosis rate. With continuous improvement of the ultrasonic instruments resolution, ultrasound doctors have done a lot of researches on the ultrasonic imaging features of renal tuberculosis, such as method of examination, ultrasound signs, ultrasonic diagnosis accuracy and comparative study with other imaging examination methods. Ultrasound provides reliable information as a kind of simple method for the diagnosis of renal tuberculosis. The purpose of this study is to explore the guiding value of ultrasonic typing of the renal tuberculosis on the clinical treatment and provide a reliable basis for clinical treatment scheme. Materials and methods1. PatientsThe clinical data of 106 patients with renal tuberculosis (totally 126 kidneys) were retrospectively reviewed. The symptoms, signs, laboratory examination of positive performance and sonographic signs of each admission patient was recorded item by item. Clinical manifestations:frequent micturition, urgent urinaiction, odynuria 63 cases, lumbago 41 cases, hematuria 29 cases and urinate lime water 1 case. Always with tuberculosis 39 cases, vertebral tuberculosis 17 cases, bladder tuberculosis 7 cases, epididymal tuberculosis 3 cases, tuberculous meningitis 3 cases, left knee joint tuberculosis 1 case and liver tuberculosis 1 case. In the 106 renal tuberculosis patients, 42 patients were confirmed by surgery,64 cases were diagnosed as renal tuberculosis by anti-tuberculosis medication effective, its 24h urine dreg smear an acid fast stain coli inspection for positive or tubercle bacillus culture is positive or urine PCR result is positive.106 renal tuberculosis patients all did ultrasonic examination,87 cases had done CT examination,49 cases had done intravenous pyelogram.2. MethodsThe ultrasound examinations were performed using standard equipment (GE Vivid7 and GE Vivid4). The probe frequencies used with both apparatuses were the same 3.5 MHz. The patients were observed via multiple cross sections in routine supine, prone and lateral positions. The size of the kidney was measured. The shape of the kidney, the intensity and homogeneous degree of the echoes reflected from the renal cortex and medulla were observed.Any abnormal echo, separation or distension of the renal sinus, calyx, pelvis, ureter, and so on, were also made note of.ResultsIn the 126 kidneys,79 kidneys were diagnosed by ultrasound, accuracy rate was 62.7%(79/126); 38 kidneys were misdiagnosed, the misdiagnosis rate was 30.2%,9 kidneys were missed diagnosis, missed diagnosis rate was 7.1%.9 missed diagnosed kidneys showed abnormal density by CT and (or) intravenous pyelogram examination, and diagnosed as renal tuberculosis combining with laboratory examination and the clinic. Combined with pathological progress, the ultrasonic images of 79 renal tuberculosis patients can be classified into the following seven categories:nodule type, 5 cases, accounting for 6.3%; cyst type,15 cases, accounting for 19.0%; hydrops type, 23 cases, accounting for 29.1%; empyema type,9 cases, accounting for 11.4%; atrophy type,11 cases, accounting for 13.9%; calcification type,6 cases, accounting for 7.6%; mixed type,10 cases, accounting for 12.7%.The CDFI of above several types all showed that section arterial flow distribution was sparse, flow rate increased, and resistance index(RI) decreased significantly, so the blood flow state was high-speed low resistance type.In 42 cases patients of surgical treatment, cyst type 5 cases, accounting for 33.3%(5/15); hydrops type 9 cases, accounting for 39.1%(9/23);empyema type 7 cases, accounting for 77.8%(7/9);atrophy type 10 cases, accounting for 90.9%(10/11); calcification type 5 cases, accounting for 83.3%(5/6); mixed type 6 cases, accounting for 60.0%(6/10); The remaining 64 cases were both treated by anti-tuberculosis medication.ConclusionUltrasonic typing of renal tuberculosis provided an important basis on diagnosing renal tuberculosis and an important and reliable information for clinical diagnosis, differential diagnosis and treatment. The majority of the nodule type, cyst type and hydrops type renal tuberculosis patients were treated only by anti-tuberculosis medication. But most of the empyema type and mixed type renal tuberculosis patients were treated by surgical therapy. Almost all the atrophy type and calcification type renal tuberculosis patients were treated by the nephrectomy.